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Defourny N, Mackenzie P, Spencer K. Health Services Research in Brachytherapy: Current Understanding and Future Challenges. Clin Oncol (R Coll Radiol) 2023; 35:548-555. [PMID: 36941146 DOI: 10.1016/j.clon.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
Brachytherapy is an integral component of cancer care. Widespread concerns have been expressed though about the need for greater brachytherapy availability across many jurisdictions. Yet, health services research in brachytherapy has lagged behind that in external beam radiotherapy. Optimal brachytherapy utilisation, to help inform expected demand, have not been defined beyond the New South Wales region in Australia, with few studies having reported observed brachytherapy utilisation. There is also a relative lack of robust cost and cost-effectiveness studies, making investment decisions in brachytherapy even more uncertain and challenging to justify, despite its key role in cancer control. As the range of indications for brachytherapy expands, providing organ/function preservation for a wider range of diagnoses, there is an urgent need to redress this balance. By outlining the work undertaken in this area to date, we highlight its importance and explore where further study is required.
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Affiliation(s)
- N Defourny
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Mackenzie
- Royal Australian and New Zealand College of Radiologists (RANZCR), The University of New South Wales, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, Sydney, Australia; St Andrew's Hospital, Toowoomba, Queensland, Australia
| | - K Spencer
- University of Leeds Faculty of Medicine and Health, Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK
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Evers J, Kerkmeijer LGW, van den Bergh RCN, van der Sangen MJC, Hulshof MCCM, Bloemers MCWM, Siesling S, Aarts MJ, Aben KKH, Struikmans H. Trends and variation in the use of radiotherapy in non-metastatic prostate cancer: A 12-year nationwide overview from the Netherlands. Radiother Oncol 2022; 177:134-142. [PMID: 36328090 DOI: 10.1016/j.radonc.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE This population-based study describes nationwide trends and variation in the use of primary radiotherapy for non-metastatic prostate cancer in The Netherlands in 2008-2019. METHODS Prostate cancer patients were selected from the Netherlands Cancer Registry (N = 103,059). Treatment trends were studied over time by prognostic risk groups. Multilevel analyses were applied to identify variables associated with external beam radiotherapy (EBRT) and brachy-monotherapy versus no active treatment in low-risk disease, and EBRT versus radical prostatectomy in intermediate and high-risk disease. RESULTS EBRT use remained stable (5-6%) in low-risk prostate cancer and increased from 21% to 32% in intermediate-risk, 37% to 45% in high-risk localized and 50% to 57% in high-risk locally advanced disease. Brachy-monotherapy decreased from 19% to 6% and from 15% to 10% in low and intermediate-risk disease, respectively, coinciding an increase of no active treatment from 55% to 73% in low-risk disease. Use of EBRT or brachy-monotherapy versus no active treatment in low-risk disease differed by region, T-stage and patient characteristics. Hospital characteristics were not associated with treatment in low-risk disease, except for availability of brachy-monotherapy in 2008-2013. Age, number of comorbidities, travel time for EBRT, prognostic risk group, and hospital characteristics were associated with EBRT versus prostatectomy in intermediate and high-risk disease. CONCLUSION Intermediate/high-risk PCa was increasingly managed with EBRT, while brachy-monotherapy in low/intermediate-risk PCa decreased. In low-risk PCa, the no active treatment-approach increased. Variation in treatment suggests treatment decision related to patient/disease characteristics. In intermediate/high-risk disease, variation seems furthermore related to the treatment modalities available in the diagnosing hospitals.
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Affiliation(s)
- Jelle Evers
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Center, Hallenweg 5, 7522 NH Enschede, the Netherlands.
| | - Linda G W Kerkmeijer
- Radboud University Medical Center, Department of Radiation Oncology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | | | - Maurice J C van der Sangen
- Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam University Medical Center, Department of Radiation Oncology, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Monique C W M Bloemers
- The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Center, Hallenweg 5, 7522 NH Enschede, the Netherlands
| | - Mieke J Aarts
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, the Netherlands
| | - Henk Struikmans
- Leiden University Medical Center, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Neupane S, Nevalainen J, Raitanen J, Talala K, Kujala P, Taari K, Tammela TLJ, Steyerberg EW, Auvinen A. Prognostic Index for Predicting Prostate Cancer Survival in a Randomized Screening Trial: Development and Validation. Cancers (Basel) 2021; 13:435. [PMID: 33498854 PMCID: PMC7865328 DOI: 10.3390/cancers13030435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
We developed and validated a prognostic index to predict survival from prostate cancer (PCa) based on the Finnish randomized screening trial (FinRSPC). Men diagnosed with localized PCa (N = 7042) were included. European Association of Urology risk groups were defined. The follow-up was divided into three periods (0-3, 3-9 and 9-20 years) for development and two corresponding validation periods (3-6 and 9-15 years). A multivariable complementary log-log regression model was used to calculate the full prognostic index. Predicted cause-specific survival at 10 years from diagnosis was calculated for the control arm using a simplified risk score at diagnosis. The full prognostic index discriminates well men with PCa with different survival. The area under the curve (AUC) was 0.83 for both the 3-6 year and 9-15 year validation periods. In the simplified risk score, patients with a low risk score at diagnosis had the most favorable survival, while the outcome was poorest for the patients with high risk scores. The prognostic index was able to distinguish well between men with higher and lower survival, and the simplified risk score can be used as a basis for decision making.
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Affiliation(s)
- Subas Neupane
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
| | - Jaakko Nevalainen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
| | - Jani Raitanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
- UKK Institute for Health Promotion Research, FI-33014 Tampere, Finland
| | - Kirsi Talala
- Finnish Cancer Registry, FI-00130 Helsinki, Finland;
| | - Paula Kujala
- Department of Pathology, FIMLAB laboratory services, FI-33014 Tampere, Finland;
| | - Kimmo Taari
- Department of Urology, Helsinki University Hospital, University of Helsinki, FI-00014 Helsinki, Finland;
| | - Teuvo L. J. Tammela
- Department of Urology, Tampere University Hospital, University of Tampere, FI-33521 Tampere, Finland;
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
| | - Anssi Auvinen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
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Yan M, Gouveia AG, Cury FL, Moideen N, Bratti VF, Patrocinio H, Berlin A, Mendez LC, Moraes FY. Practical considerations for prostate hypofractionation in the developing world. Nat Rev Urol 2021; 18:669-685. [PMID: 34389825 PMCID: PMC8361822 DOI: 10.1038/s41585-021-00498-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
External beam radiotherapy is an effective curative treatment option for localized prostate cancer, the most common cancer in men worldwide. However, conventionally fractionated courses of curative external beam radiotherapy are usually 8-9 weeks long, resulting in a substantial burden to patients and the health-care system. This problem is exacerbated in low-income and middle-income countries where health-care resources might be scarce and patient funds limited. Trials have shown a clinical equipoise between hypofractionated schedules of radiotherapy and conventionally fractionated treatments, with the advantage of drastically shortening treatment durations with the use of hypofractionation. The hypofractionated schedules are supported by modern consensus guidelines for implementation in clinical practice. Furthermore, several economic evaluations have shown improved cost effectiveness of hypofractionated therapy compared with conventional schedules. However, these techniques demand complex infrastructure and advanced personnel training. Thus, a number of practical considerations must be borne in mind when implementing hypofractionation in low-income and middle-income countries, but the potential gain in the treatment of this patient population is substantial.
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Affiliation(s)
- Michael Yan
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
| | - Andre G. Gouveia
- Department of Radiation Oncology, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Fabio L. Cury
- grid.14709.3b0000 0004 1936 8649Department of Radiation Oncology, Cedars Cancer Centre, McGill University, Montreal, Canada
| | - Nikitha Moideen
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
| | - Vanessa F. Bratti
- grid.410356.50000 0004 1936 8331Queen’s University School of Medicine, Department of Public Health Sciences, Kingston, Canada
| | - Horacio Patrocinio
- grid.14709.3b0000 0004 1936 8649Department of Medical Physics, Cedars Cancer Centre, McGill University, Montreal, Canada
| | - Alejandro Berlin
- grid.17063.330000 0001 2157 2938Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Lucas C. Mendez
- grid.39381.300000 0004 1936 8884Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Canada
| | - Fabio Y. Moraes
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
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Martell K, Mendez LC, Chung HT, Tseng CL, Alayed Y, Cheung P, Liu S, Vesprini D, Chu W, Wronski M, Szumacher E, Ravi A, Loblaw A, Morton G. Results of 15 Gy HDR-BT boost plus EBRT in intermediate-risk prostate cancer: Analysis of over 500 patients. Radiother Oncol 2019; 141:149-155. [PMID: 31522882 DOI: 10.1016/j.radonc.2019.08.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE/OBJECTIVE To report biochemical control associated with single fraction 15 Gy high-dose-rate brachytherapy (HDR-BT) boost followed by external beam radiation (EBRT) in patients with intermediate-risk prostate cancer. MATERIALS AND METHODS A retrospective chart review of all patients with intermediate-risk disease treated with a real-time ultrasound-based 15 Gy HDR-BT boost followed by EBRT between 2009 and 2016 at a single quaternary cancer center was performed. Freedom from biochemical failure (FFBF), cumulative incidence of androgen deprivation therapy use for biochemical or clinical failure post-treatment (CI of ADT) and metastasis-free survival (MFS) outcomes were measured. RESULTS 518 patients met the inclusion criteria for this study. Median age at HDR-BT was 67 years (IQR 61-72). 506 (98%) had complete pathologic information available. Of these, 146 (28%) had favorable (FIR) and 360 (69%) had unfavorable (UIR) intermediate-risk disease. 83 (16%) received short course hormones with EBRT + HDR. Median overall follow-up was 5.2 years. FFBF was 91 (88-94)% at 5 years. Five-year FFBF was 94 (89-99)% and 89 (85-94)% in FIR and UIR patients, respectively (p = 0.045). CI of ADT was 4 (2-6)% at 5 years. Five-year CI of ADT was 1 (0-3)% and 5 (2-8)% in FIR and UIR patients, respectively (p = 0.085). MFS was 97 (95-98)% at 5 years. Five-year MFS was 100 (N/A-100)% and 95 (92-98)% in FIR and UIR patients, respectively (p = 0.020). CONCLUSION In this large cohort of intermediate-risk prostate cancer patients, 15 Gy HDR-BT boost plus EBRT results in durable biochemical control and low rates of ADT use for biochemical failure.
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Affiliation(s)
- K Martell
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - L C Mendez
- University of Toronto, Department of Radiation Oncology, Canada; Western University, Department of Radiation Oncology, London, Canada; London Health Sciences Centre, Canada
| | - H T Chung
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - C L Tseng
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Y Alayed
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Radiation Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - P Cheung
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - S Liu
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - D Vesprini
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - W Chu
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Wronski
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - E Szumacher
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Ravi
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Loblaw
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - G Morton
- University of Toronto, Department of Radiation Oncology, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
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Martin JM, Supiot S, Keall PJ, Catton CN. Moderately hypofractionated prostate external-beam radiotherapy: an emerging standard. Br J Radiol 2018; 91:20170807. [PMID: 29322821 PMCID: PMC6223284 DOI: 10.1259/bjr.20170807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/01/2023] Open
Abstract
Research over recent years has demonstrated that curative external-beam radiotherapy can be safely and efficaciously delivered with roughly half the number of treatments which was previously considered standard. We review the data supporting this change in practice, methods for implementation, as well as emerging future directions.
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Affiliation(s)
- Jarad M Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, NSW, Australia
| | - Stephane Supiot
- Département de Radiothérapie, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Paul J Keall
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, New South Wales, NSW, Australia
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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Hanna TP, Shafiq J, Delaney GP, Vinod SK, Thompson SR, Barton MB. The population benefit of evidence-based radiotherapy: 5-Year local control and overall survival benefits. Radiother Oncol 2017; 126:191-197. [PMID: 29229506 DOI: 10.1016/j.radonc.2017.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND To describe the population benefit of radiotherapy in a high-income setting if evidence-based guidelines were routinely followed. METHODS Australian decision tree models were utilized. Radiotherapy alone (RT) benefit was defined as the absolute proportional benefit of radiotherapy compared with no treatment for radical indications, and of radiotherapy over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemoradiotherapy over RT. Five-year local control (LC) and overall survival (OS) benefits were measured. Citation databases were systematically queried for benefit data. Meta-analysis and sensitivity analysis were performed. FINDINGS 48% of all cancer patients have indications for radiotherapy, 34% curative and 14% palliative. RT provides 5-year LC benefit in 10.4% of all cancer patients (95% Confidence Interval 9.3, 11.8) and 5-year OS benefit in 2.4% (2.1, 2.7). CRT provides 5-year LC benefit in an additional 0.6% of all cancer patients (0.5, 0.6), and 5-year OS benefit for an additional 0.3% (0.2, 0.4). RT benefit was greatest for head and neck (LC 32%, OS 16%), and cervix (LC 33%, OS 18%). CRT LC benefit was greatest for rectum (6%) and OS for cervix (3%) and brain (3%). Sensitivity analysis confirmed a robust model. INTERPRETATION Radiotherapy provides significant 5-year LC and OS benefits as part of evidence-based cancer care. CRT provides modest additional benefits.
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Affiliation(s)
- T P Hanna
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia; Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Canada.
| | - J Shafiq
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia; South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - G P Delaney
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia
| | - S K Vinod
- South Western Sydney Clinical School, UNSW, Sydney, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - S R Thompson
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia; Department of Radiation Oncology, Prince of Wales Hospital, Sydney, Australia
| | - M B Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia
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Mendez LC, Moraes FY, Fernandes GDS, Weltman E. Cancer Deaths due to Lack of Universal Access to Radiotherapy in the Brazilian Public Health System. Clin Oncol (R Coll Radiol) 2017; 30:e29-e36. [PMID: 28988891 DOI: 10.1016/j.clon.2017.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/22/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
AIMS Radiotherapy plays a fundamental role in the treatment of cancer. Currently, the Brazilian public health system cannot match the national radiotherapy demand and many patients requiring radiotherapy are never exposed to this treatment. This study estimated the number of preventable deaths in the public health system if access to radiotherapy was universal. MATERIALS AND METHODS Incidence rates for the year 2016 provided by Instituto Nacional de Cancer were used in this analysis. The number of untreated patients requiring radiotherapy was obtained through the difference between the total number of patients requiring radiotherapy and the total amount of delivered radiotherapy treatments in the public health system. The number of deaths for the three most common cancers in each gender due to radiotherapy shortage was calculated. Initially, the total number of patients per cancer type was divided in stages using Brazilian epidemiological data. Subsequently, previously published tree arm diagrams were used to define the rate of patients requiring radiotherapy in each specific clinical setting. Finally, the clinical benefit of radiotherapy in overall survival was extracted from studies with level 1 evidence. RESULTS Over 596 000 cancer cases were expected in Brazil in 2016. The public health system covers more than 75% of the Brazilian population and an estimated 111 432 patients who required radiotherapy in 2016 did not receive this treatment. Breast, colorectal and cervix cancers are the most frequent malignant tumours in women and prostate, lung and colorectal in men. The number of deaths due to a radiotherapy shortage in the year 2016 for these types of cancer were: (i) breast: 1011 deaths in 10 years; (ii) cervix: 2006 deaths in 2 years; (iii) lung: 1206 deaths in 2 years; (iv) prostate, intermediate risk: 562 deaths in 13 years; high risk: 298 deaths in 10 years; (v) colorectal: 0 deaths, as radiotherapy has no proven benefit in overall survival. CONCLUSION Thousands of cancer patients requiring radiotherapy do not have access to this treatment in the Brazilian public health system. The shortage of radiotherapy has a significant detrimental effect on cancer survival; over 5000 deaths would probably be prevented in the most common cancer types if radiotherapy access was universal.
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Affiliation(s)
- L C Mendez
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | - F Y Moraes
- Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - G Dos S Fernandes
- Hospital Sírio-Libanês, Brasilia, Brazil; Sociedade Brasileira de Oncologia Clinica, Brazil
| | - E Weltman
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Sociedade Brasileira de Radioterapia, Brazil
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Hrubý M, Kučka J, Pánek J, Štěpánek P. Seven years of radionuclide laboratory at IMC - important achievements. Physiol Res 2016; 65:S191-S201. [PMID: 27762585 DOI: 10.33549/physiolres.933421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
For many important research topics in polymer science the use of radionuclides brings significant benefits concerning nanotechnology, polymer drug delivery systems, tissue engineering etc. This contribution describes important achievements of the radionuclide laboratory at Institute of Macromolecular Chemistry of the Academy of Sciences of the Czech Republic (IMC) in the area of polymers for biomedical applications. Particular emphasis will be given to water-soluble polymer carriers of radionuclides, thermoresponsive polymer radionuclide carriers, thermoresponsive polymers for local brachytherapy, polymer scaffolds modified with (radiolabeled) peptides and polymer copper chelators for the therapy of Wilson´s disease.
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Affiliation(s)
- M Hrubý
- Institute of Macromolecular Chemistry of the Czech Academy of Sciences, Prague, Czech Republic.
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10
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Bece A, Bucci J. Prostate brachytherapy: Why do we ignore the evidence? J Med Imaging Radiat Oncol 2016; 60:528-30. [DOI: 10.1111/1754-9485.12472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Andrej Bece
- Cancer Care Centre; St George Hospital; Kogarah New South Wales Australia
| | - Joseph Bucci
- Cancer Care Centre; St George Hospital; Kogarah New South Wales Australia
- Genesis CancerCare Hurstville; Hurstville New South Wales Australia
- Faculty of Medicine; University of New South Wales; Kensington New South Wales Australia
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